Airway obstruction upper

The history and physical examination should be obtained while initial therapy is being provided. A history of previous asthma exacerbations (e.g., hospitalizations, intubations) and complicating illnesses (e.g., cardiac disease, diabetes) should be obtained. The patient should be examined to assess hydration status use of accessory muscles of respiration and the presence of cyanosis, pneumonia, pneumothorax, pneumomediastinum, and upper airway obstruction. A complete blood count may be appropriate for patients with fever or purulent sputum. 

Botulism. Clinical features include symmetric cranial neuropathies (i.e., drooping eyelids, weakened jaw clench, and difficulty swallowing or speaking), blurred vision or diplopia, symmetric descending weakness in a proximal to distal pattern, and respiratory dysfunction from respiratory muscle paralysis or upper airway obstruction without sensory deficits. Inhalational botulism would have a similar clinical presentation as food-borne botulism however, the gastrointestinal symptoms that accompany foodborne botulism may be absent. 

Exposure to and inhalation of concentrations of 2500-6500ppm, as might result from accidents with liquid anhydrous ammonia, cause severe corneal irritation, dyspnea, bron-chospasm, chest pain, and pulmonary edema that may be fatal. Upper airway obstruction due to laryngeal/pharyngeal edema and desquamation of mucous membranes may occur early in the course and require endotracheal intubation or tracheostomy. " Case reports have documented chronic airway hyperreactivity and asthma, with associated obstructive pulmonary function changes after massive ammonia exposures. ... 

Injection - Heart failure secondary to chronic lung disease cardiac arrhythmias brain tumor acute alcoholism delirium tremens idiosyncrasy to the drug increased intracranial or CSF pressure head injuries acute bronchial asthma upper airway obstruction. Because of its stimulating effect on the spinal cord, morphine should not be used in convulsive states (eg, status epilepticus, tetanus, strychnine poisoning) concomitantly with MAOIs or in those who have received such agents within 14 days. 

Epidural/Intrathecal- Presence of infection at the injection microinfusion site concomitant anticoagulant therapy uncontrolled bleeding diathesis parenterally administered corticosteroids within a 2-week period, other concomitant drug therapy or medical condition that would contraindicate the technique of epidural or intrathecal analgesia acute bronchial asthma upper airway obstruction. 

DepoDur- Respiratory depression acute or severe bronchial asthma upper airway obstruction paralytic ileus head injury increased intracranial pressure circulatory shock. 

Oxymorphone Hypersensitivity to morphine analogs acute asthma attack severe respiratory depression or upper airway obstruction paralytic ileus pulmonary edema secondary to a chemical respiratory irritant. 

Inflammatory effect. A case of a 17-year-old male regular cannabis user who developed a large swollen uvula (uvulitis) and partial upper airway obstruction after smoking cannabis was evaluated. Symptoms resolved with the administration of corticosteroids and antihistamines ". A healthy 17-year-old man who inhaled cannabis prior to general anesthesia is described. In the recovery room, after an... 

Boyce, S. H. and M. A. Quigley. Uvu-litis and partial upper airway obstruction following cannabis inhalation. Emerg Med (Fremantle) 2002 14(1) ... 

Contraindications Paralytic ileus, acute asthma attack, pulmonary edema secondary to chemical respiratory irritant, severe respiratory depression, upper airway obstruction... 

Corneal clouding, mental retardation, dwarfing, coarse facial features, upper airway obstruction. 

Saaresranta T, Polo-Kantola P, Rauhala E, Polo O (2001) Medroxyprogesterone in postmenopausal females with partial upper airway obstruction during sleep. Eur Respir J 18 989-995... 

One highly exposed individual died, and the other 2 had upper airway obstruction that necessitated early intubation or tracheostomy, bums to the skin and mucous membranes of the upper airway, and epithelial defects of the cornea Individuals recovered with few respiratory sequelae. 

Inhalational induction, usually with sevo-flurane, is undertaken taken less commonly. It is used in children, particularly if intravenous access is difficult, and in patients at risk from upper airway obstruction. 

Hiccups during anesthesia are often thought to be benign. Negative pressure pulmonary edema is usually associated with an obstructed airway, as occurs with laryngospasm, or other causes of upper airway obstruction, but was presumably the cause in this child. 

Excessive volumes of local anesthetic in a confined space can lead to life-threatening upper airway obstruction. When glossopharyngeal nerve blocks are used for tonsillectomy, children under 15 kg should be given 1 ml or less of 0.25% bupivacaine per tonsil (350). 

Sher MH, Laing Dl, Brands E. Life-threatening upper airway obstruction after glossopharyngeal nerve block possibly due to an inappropriately large dose of bupivacaine Anesth Analg 1998 86(3) 678. 

KniU RL. D-tubocurarine and upper airway obstruction a historical perspective. Anesthesiology 1989 71(3) 480-1. 

Exposures by inhalation should be monitored for respiratory tract irritation, upper airway obstruction, bronchitis, or pneumonitis. Humidified supplemental 100% oxygen should be administered to help soothe bronchial irritation. Oxygen, in combination with intubation and mechanical ventilation, may be required in severe cases. Exposed eyes and skin should be irrigated immediately with copious amounts of water eyes should be washed for at least 30 min or until the eye reached neutral pH as tested in the... 

Patients may develop severe cutaneous hyper-sensivity or systemic allergic reactions. Signs may include the development of an urticarial hive-type reaction, facial or tongue swelling, bronchospasm, and acute upper airway obstruction. Treatment includes antihistamines, corticosteroids, and, if necessary, epinephrine. 

Although no fatalities have been validated following exposure to CS, there have been several cases of serious consequences. A documented case of pneumonia is reported in a normal 4-month-old white male infant exposed to CS gas for 2-3 h. Immediately when taken to the emergency room he was observed to have copious nasal and oral secretions, sneezed and coughed frequently, and required suction to relieve upper airway obstruction. The pneumonitis... 

Respiratory Effects. The only information located regarding the respiratory effects of gasoline following dermal exposure comes from a case report in which a 34-year-old man suffered from atelectasis, laryngeal edema, and upper airway obstruction following immersion in a pool of unleaded gasoline for approximately 8 hours after an automobile accident (Simpson and Cruse 1981). Exposure by other routes was possible. 

Respiratory dysfunction from respiratory muscle paralysis or upper airway obstruction... 

Spirometry is the most widely available and useful PFT. It takes only 15 to 20 minutes, carries no risks, and provides information about obstructive and restrictive disease. Spirometry allows for the measurement of aU lung volumes and capacities except RV, FRC, and TLC and allows assessment of FEVi and FEF25%-7s%. Spirometry measurements can be reported in two different formats—standard spirometry (Eig. 25-2) and the flow-volume loop (Fig. 25-3). In standard spirometry, the volumes are recorded on the vertical (y) axis and the time on the horizontal (x) axis. In flow-volume loops, volume is plotted on the horizontal (x) axis, and flow (derived from volume/time) is plotted on the vertical (y) axis. The shape of the flow-volume loop can be helpful in differentiating obstructive and restrictive defects and in the diagnosis of upper airway obstruction (Fig. 25 ). This curve gives a visual representation of obstruction because the expiratory descent becomes more concave with worsening obstruction. 

Another test used to distinguish upper airway obstruction from COPD and asthma is the FEVi/FEVq.s (FEV at 1 second/FEV at 0.5 second). This ratio is usually greater than 1.5 in patients with upper airway obstruction. This is so because the FEV0.5 is proportionately more reduced in upper airway obstruction because forced expiration measured at 0.5 second better reflects obstruction at high lung volumes. The abnormahty seen on the flow-volume loop has been referred to as straightening of the curve during early expiration. 

Acres JC, Kryger MH. Upper airway obstruction. Chest 1981 80 207-211. 

Bright P, Miller MR, Franklyn JA, et al. The use of a neural network to detect upper airway obstruction caused by goiter. Am J Respir Crit Care Med 1998 157 1885-1891. 

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